AB0252 IMPACT OF ADHERENCE TO THE MEDITERRANEAN DIET ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: S. Rekik, S. Nouicer, S. Boussaid, S. Rahmouni, K. Zouaoui, H. Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The Mediterranean diet (MD), mainly consists of olive oil, cereal products, fresh or dried fruit and vegetables, nuts, a moderate amount of dairy and meat, and many condiments and spices, has been suggested to have a beneficial effect on mortality and cardiovascular diseases. However, there is limited evidence regarding its impact on rheumatoid arthritis (RA) disease activity. <h3>Objectives</h3> The aim of this study was to assess association between adherence to MD and disease activity in RA patients. <h3>Methods</h3> In this cross-sectional study, we included patients with RA in remission or low disease activity. Patients with intestinal disease and smorkers were not included. Socio demographic data (age, sexe, educational level and living area) were recorded. Tender and Swollen Joint Count (T/SJC), Disease Activty Score (DAS28), Clinical Disease Activity Index (CDAI) and Score Disease Activity Index (SDAI) were used to access disease activity. Levels of C-reactive protein (CRP) and hemoglobine (Hb) were determined. Medication (paracetamol, Non Steroidal Anti-inflammatory Arugs (NSAIDs) and Disease-modifying antirheumatic drugs (DMARDs)) were recorded. We assessed MD adherence through a 14-item questionnaire in RA patient. The MD adherence score was classified as follows: good adherence (≥ 10 points) and low and medium adherence (≤ 9 points). We divided patients into two groups: G1: good adherence and G2: low and medium adherence to MD. We compared parameters of G1 and G2 using the Mann-Whitney U test. <h3>Results</h3> We enrolled 39 patients (34 female) with mean age of 52.74 ± 11.31 [20-74] years. Most of patients lived in rural area (61.5%). Half of patients (53.8%) had primary school level. The mean disease duration was 8.68 ± 6.6 years. The mean CRP and Hb levels were respectively 2.9 ± 9.67 [0-21] and 11.72 ± 1.4 [10-14]. The mean DAS28, CDAI and SDAI were respectively: 2.06 ± 0.71 [1-3.1], 5.46 ± 3.4 [1-10] and 8.26 ± 5.62 [2-28]. The most of patients were on paracetamol (53.9%) and conventional synthetic DMARDs (82.1%). NSAID were used by 35.9% of patients. The mean MD score was 9.1 ± 2.67 [4-12]. G1 enrolled 20 patients and G2 19. No significant differences emerged in the distribution of sexe, age, living area and educational level between two groups. G1 had significant lower disease activity in comparison to G2: (median [extrema]) TJC (0 [0-1] vs 1 [0-2], p=0.02), DAS28 (1.7 [1 - 3.1] vs 2.2 [1.7-3.1], p=0.001), CDAI (2 [1-7] vs 9 [3 - 11] p&lt;0.001) and SDAI (4 [2 - 9] vs 11 [5 - 30], p&lt;0.001). No significant differences was observed in SJC and CRP level, p=0.11 and p=0.22 respectively. However, Hb levels were higher in G1 (13 [13-14]) than in G2 (10 [10-13]), p&lt;0.001. G2 had higher paracetamol and NSAID consumption with 84.3% and 57.9% vs 57.9% and 84.3 % respectively. Less use of biological DMARD were observed in G1 since all patients were on conventional synthetic DMARDs. <h3>Conclusion</h3> In our study, higher adherence to a MD was associated with reduced RA activity, symptomatic treatement consumption and more remission and low disease activity with conventional synthetic DMARD. Therefore, nutritional therapy could be a promising adjunct to pharmacological therapy in RA. Further studies are needed to confirm these findings. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.